Clınıcopathologıc Analysıs of the Premalıgnant and Malıgnant Stages of Prolıferatıve Verrucous Leukoplakıa: A Lıterature Revıew

Objective: Proliferative verrucous leukoplakia is a potentially malignant disorder that is unreactive to most standard treatments. Patients experience multiple, multifocal, and recurrent leukoplakias that usually progress into verrucous premalignant lesions (verrucous hyperplasia) and malignant tumors (PVL-associated squamous cell carcinoma). There is no single histologic definition of PVL, and the diagnosis is retrospective following observed progression of the disorder. The goal of the current study was to conduct a literature review on the clinicopathologic features of proliferative verrucous leukoplakia in the premalignant and malignant stages.

Method: Medline`s PubMed and Google Scholar were searched for adequately documented cases from 1985-2018. References of published articles were searched for additional cases.

57 manuscripts provided adequate data on the malignant transformation rate and microscopic evidence of dysplasia. 35/57 manuscripts provided data on the clinicopathologic features of the premalignant and malignant stages.

Results: Malignant transformation occurred in 50% of PVL patients within an average of 57 months. Gingiva, palate and buccal mucosa were the most common locations. Clinicopathologic features: well differentiated carcinoma (78%), perineural invasion (3%), lymph node metastasis (4%); distant metastasis (0%), average duration of illness (65 months), DOD-dead of disease (44%). Moderate dysplasia, severe dysplasia and carcinoma in situ were exceptionally uncommon in the premalignant stages (0.8%).

Conclusion: Prognostic factors such as perineural invasion, lymph node metastasis and distant metastasis were uncommon occurrences which may have practical implications on treatment. Further studies are needed in order to substantiate our findings.